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III IIIIIIIIIIIII III <br />E ~ .. <br />_~ ~ - ~ STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />Deparimanl of Natural Resources ~d+~ <br />~~~~g <br />7377 Shem7ar7 St., Room 275 ~j <br />" Demar. CO 80203 • ~ 8 <br />107 866-7567 '~• <br />FA%: 300 832-8106 re7e' <br />~ ~. <br />cohnnr <br />~ Frae R. Barra. <br />APPLICATION FORM FOR A REVISION Div~siai Diraclw <br />it <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of <br />your revision including maps must be submitted in order for it to be complete. <br />A71 revisions are to be formatted so they can be inserted into the permit to <br />replace the revised sections, asps, tables and/ar figures. Explain 1n the <br />revision what section 1s being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 81102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C - g ( - O -3 ~ <br />Date: Q g / Q ~/ ~ 3 RECEIV~p <br />Permittee: E~/ ~Q N - C Q g ~ - ~o -- BUG 41993 <br />Street: €' .Q ~~ ~ - /~ O. ~bX //8z~vision of tillner~„ ~ ,,,,,.,~" <br />--------------- <br />city: Nou~sr~v Zc^x.4_5------------ <br />State: ~~( Zip Code: Z Z ~? s 1, - 1 (g ~ <br />Mine Name: L1C~EK~2 ~~} /1'Jln~t~s-------- <br />Brief Description of Revision: ~~~~~~- SMA[L~~(~ytJ~jF'7~1F <br />~tsE,______________ <br />Public Notice Attached -Yes J _ No (Required for PR's and TR's) <br />Bond Increase: Yes No J Federal J Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) <br />Permit Area (+/-) <br />State Land (+/-) <br />6185E (10/90) <br />- - 0 .- Acres <br />- _ O .- Acres <br />~ Acres <br />Affected Area (+/-) - - ~.- Acres <br />Federal Land (+/_) - - ~ Acres <br />Private Land (+/_) Q Acres <br />